This post’s title question turns out to be quite tricky. According to a recent study (RL Rosen et al. JPGN 2016; 63: 210-17), reflux burden, even in children that aspirate did not correlate with increased hospitalization.
Here are the details:
Methods: Prospectively recruited cohort of 116 children who had both pH-impedance testing along with modified barium swallow. The authors considered pathologic reflux to have at least 73 episodes on pH-impedance or if pH<4 for >6% of study period.
- There was no statistical correlation between pH-impedance study results and total number of admissions even with or without adjusting for aspiration status (and neurologic complications).
When the authors tried to reconcile these findings, they offered three competing potential explanations for these results:
- Reflux has little impact on hospitalziations
- Our methods for measuring reflux are not good
- Even “normal” reflux can be a problem for those prone to complications; therefore, reflux burden is not consequential.
What is clear is that pH-impedance studies cannot predict which patients are at risk for increased complications. This is supported by data showing that ‘reflux-related’ hospitalizations may not improve after fundoplication (Pediatrics 2006; 118: 2326-33; J Pediatr Surg 2008; 43: 59-63). One particularly important limitation was that the cause of hospitalizations was determined by medical record review.
My take: A simple algorithm for preventing aspiration pneumonia does not exist. Even the role of reflux testing is uncertain.
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